JPWO2014141530A1 - THERAPEUTIC TREATMENT DEVICE AND THERAPEUTIC TREATMENT METHOD - Google Patents

Abstract

In a treatment tool for applying energy to a living tissue, the device includes an energy output unit including an energy applying surface for applying high-frequency energy to the living tissue, and a coating member covering the energy applying surface. A therapeutic treatment instrument constituted by Ni-PTFE which is nickel (Ni) containing polytetrafluoroethylene (PTFE) at a content of 30% or more.

Description

  The present invention relates to a therapeutic treatment tool and a therapeutic treatment method for treating a living tissue by applying energy.

  Conventionally, various treatment tools and treatment methods for treating a living tissue by applying energy have been proposed.

  Here, as examples of the energy applied to join the living tissues, for example, high-frequency energy and resistance heating energy can be given. The energy application surface for applying such energy may be coated to ensure insulation or prevent adhesion of living tissue.

  For example, paragraph [0025] of US Patent Application Publication No. 2006 / 0111711A1 describes that a pair of jaws is formed of iron and coated with 1 mm of barium titanate ceramic dielectric. .

  In addition, paragraph [0083] of US Patent Application Publication No. 2005 / 0004569A1 describes a non-dielectric material in which an insulator member constituting a surface in contact with a tissue is not sticky such as polytetrafluoroethylene (PTFE), polypropylene-polystyrene, polycarbonate or the like. It is described that the body is formed.

  Furthermore, paragraph [0027] of US 2007/0055231 A1 describes coating the outer peripheral surface of the jaw member (and hence not the energy application surface) with a substance that reduces tissue adhesion. Some examples of coating materials include polytetrafluoroethylene (PTFE).

  And in paragraph [0037] of US Patent Application Publication No. 2006 / 0276785A1, in order to reduce the burning of protein to the arm tip of the bipolar tweezers, the opposing surface of the arm tip of the stainless steel tweezers is Covering with a composite plating film is described. This publication describes four examples in which PTFE particles are compounded with a noble metal material to form a composite plating film. Examples 2 and 4 are examples in which nickel is used in place of the noble metal material. It has become. Specifically, Example 2 described in paragraph [0044] of the publication uses nickel instead of gold as a noble metal material, and PTEE having an average particle diameter of 5 μm (description of paragraph [0027] and other parts). Therefore, it is an example of forming a composite plating film by compositing fine particles (which may be mistaken for PTFE). The amount of fine particles added to the composite plating film in Example 2 is 15.2% by weight (or 22.8% by volume). Also, Example 4 described in paragraph [0046] of the publication uses an example in which nickel is used in place of platinum as a noble metal material and PTFE fine particles having an average particle diameter of 6 μm are compounded to form a composite plating film. It has become. The amount of fine particles added to the composite plating film in Example 3 is 5.4% by weight (or 16.8% by volume).

  Various proposals have been made in this way, but the attachment of the living tissue to the energy application surface for applying energy, for example, high frequency energy (or resistance heating energy in addition to the high frequency energy) to the living tissue is more efficient. It is desirable that it can be prevented.

  The present invention has been made in view of the above circumstances, and provides a therapeutic treatment tool and a therapeutic treatment method that can more efficiently prevent adhesion of a biological tissue to an energy application surface that applies energy to the biological tissue. The purpose is to do.

  The therapeutic treatment tool according to one aspect of the present invention is a therapeutic treatment tool for treating a living tissue by applying energy, and an energy output unit including an energy application surface for applying high-frequency energy to the living tissue, and containing 30% or more A coating member that is made of Ni-PTFE, which is nickel (Ni) containing polytetrafluoroethylene (PTFE) in an amount, and covers the energy application surface.

  According to another aspect of the present invention, there is provided a therapeutic treatment method for treating a biological tissue by applying energy, wherein an energy application surface is brought into contact with the biological tissue, and the energy application surface is contacted with the biological tissue. The energy application surface is made of Ni-PTFE, which is nickel (Ni) containing polytetrafluoroethylene (PTFE) at a content of 30% or more while being in contact with the coating member covering the energy application surface. When the cells of the living tissue are dehydrated by applying high-frequency energy to the living tissue and applying the high-frequency energy to the living tissue, resistance heating energy is applied to the living tissue from the energy application surface. Then, after the biological tissue is treated and the biological tissue is treated, the coating portion The energized surface covered by a method of separating from the living body tissue.

The perspective view which shows the structure of the therapeutic treatment system provided with the linear type therapeutic treatment tool in the 1st Embodiment of this invention. The longitudinal cross-sectional view which shows the clamping part of the closed state of the shaft of the treatment tool in the said 1st Embodiment. The longitudinal cross-sectional view which shows the clamping part of the open state of the shaft of the treatment tool in the said 1st Embodiment. The top view which shows the 1st clamping member of the treatment tool in the said 1st Embodiment. 5-5 sectional drawing in FIG. 4 of the 1st clamping member of the treatment tool in the said 1st Embodiment. The perspective view which shows the back surface of the 1st high frequency electrode in which the resistance heater is provided in the said 1st Embodiment. The perspective view which shows the other structural example of the resistance heater provided in the back surface of the 1st high frequency electrode in the said 1st Embodiment. In the said 1st Embodiment, the graph which shows the experiment example of the durable frequency | count that a biological tissue does not adhere when content of PTFE with respect to nickel Ni is varied on a certain condition. The block diagram which shows mainly the electrical structure of the treatment system in the said 1st Embodiment. The flowchart which shows the process at the time of performing the treatment using a high frequency energy and a thermal energy to a biological tissue using the therapeutic treatment system of the said 1st Embodiment. The top view which shows the shape of the 1st high frequency electrode provided in the 1st clamping member in the 2nd Embodiment of this invention. 12-12 sectional drawing which shows the structure of the 1st clamping member in which the 1st high frequency electrode was provided in the said 2nd Embodiment. The side view which shows the structure of the clamping part comprised as a seesaw type of the treatment tool in the 3rd Embodiment of this invention. The perspective view which shows the structure of the therapeutic treatment system provided with the circular type therapeutic treatment tool in the 4th Embodiment of this invention. The top view which shows the structure of the clamping surface of the main body side clamping part of a treatment instrument in the said 4th Embodiment. The perspective view which shows the structure of the electric knife which is the therapeutic treatment tool of the 5th Embodiment of this invention. The perspective view which shows the structure of the bipolar tweezers which are the therapeutic treatment tools of the 6th Embodiment of this invention. The side view which shows the structure of the snare type | mold incision excision tool which is the therapeutic treatment tool of the 7th Embodiment of this invention.

  Embodiments of the present invention will be described below with reference to the drawings.

[First Embodiment]
FIG. 1 to FIG. 10 show a first embodiment of the present invention, and FIG. 1 is a perspective view showing a configuration of a treatment system having a linear type treatment device.

  In the present embodiment, the therapeutic treatment tool (energy treatment tool) is a linear type therapeutic treatment tool 2 for performing a treatment through a body wall, for example. However, it may be an open linear type treatment instrument that takes out a living tissue to be treated out of the body through the body wall and performs treatment.

  As shown in FIG. 1, the therapeutic treatment system 1 includes a therapeutic treatment instrument 2, an energy source 4, and a foot switch 6.

  The treatment instrument 2 includes a handle 11, an elongated shaft 12 extending to the distal end side of the handle 11, and an openable / closable clamping portion 13 disposed on the distal end side of the shaft 12.

  The handle 11 is connected to the energy source 4 having the display unit 43 via the cable 16. The energy source 4 is connected to a foot switch 6 having a pedal 6a (but not limited to a foot switch, for example, a hand switch). When the operator operates the pedal 6a of the foot switch 6, ON / OFF of energy supply from the energy source 4 to the treatment instrument 2 can be switched.

  The handle 11 is formed in a shape that is easy for an operator to grip, for example, a substantially L-shape. A shaft 12 is disposed at one end of the handle 11. On the other hand, the cable 16 described above extends from the proximal end of the handle 11 that is coaxial with the shaft 12. Further, the other end side of the handle 11 is a grasping portion 11a that is held by a surgeon with a hand.

  The handle 11 includes a holding portion opening / closing lever 14 provided so as to be rotatable so as to be arranged in parallel with the grip portion 11a. The sandwiching portion opening / closing lever 14 is connected to a proximal end portion of a later-described sheath 34 (see FIGS. 2 and 3) constituting the outer shell of the shaft 12 at a substantially central portion of the handle 11. When the sandwiching section opening / closing lever 14 is operated so as to approach or separate from the gripping section 11 a of the handle 11, the sheath 34 moves along the axial direction of the shaft 12. When the sheath 34 moves to the distal end side in the axial direction of the shaft 12, the sandwiching portion 13 is closed, and when the sheath 34 moves to the proximal end side in the axial direction, the sandwiching portion 13 opens.

  The handle 11 is further provided with a cutter drive lever 15 provided so as to be rotatable so as to be juxtaposed with the holding portion opening / closing lever 14. When the cutter driving lever 15 is operated so as to approach or separate from the grip portion 11a of the handle 11, a cutter 36 (see FIG. 2 and FIG. 3), which will be described later, moves along the axial direction of the shaft 12, and living tissue Cutting is to be performed.

  FIG. 2 is a longitudinal sectional view showing the shaft of the treatment instrument and the sandwiched portion in the closed state, and FIG. 3 is a longitudinal sectional view showing the shaft of the treatment instrument and the sandwiched portion in the opened state.

  As shown in FIGS. 2 and 3, the shaft 12 includes, for example, a cylindrical body 33 having a substantially cylindrical shape, and a thin-cylindrical sheath 34 that is slidable with respect to the outer periphery of the cylindrical body 33. I have. The cylindrical body 33 is fixed to the handle 11 (see FIG. 1) at its proximal end. The sheath 34 is slidable along the axial direction of the cylindrical body 33.

  A groove 33 a along the axial direction of the cylinder 33 is formed on the outer periphery of the cylinder 33. A first high-frequency electrode energization line 21e and a heater energization line 22a are disposed in the groove 33a. The first high-frequency electrode energization line 21e is connected to a first high-frequency electrode 21a described later, and the heater energization line 22a is connected to a resistance heater 22 described later.

  The second high-frequency electrode energization line 21 f is inserted into the cylindrical body 33. The second high-frequency electrode conducting line 21f is connected to a second high-frequency electrode 21b described later.

  Further, a drive rod 35 having a cylindrical shape, for example, is disposed inside the cylinder 33 so as to be movable along the axial direction thereof. A thin plate-like cutter 36 as a treatment assisting tool is fixed to the distal end portion of the drive rod 35. Further, the base end portion of the drive rod 35 is connected to the cutter drive lever 15. Accordingly, when the cutter drive lever 15 is operated, the cutter 36 moves in the axial direction via the drive rod 35.

  The cutter 36 is formed with a blade 36a for cutting the living tissue at the tip thereof. A long hole 36 b serving as an axial guide hole is formed between the distal end and the proximal end of the cutter 36. A movement restricting pin 37 is engaged with the long hole 36b. The movement restricting pin 37 is fixed to the cylindrical body 33 so as to extend in a direction orthogonal to the axial direction of the shaft 12. For this reason, the cutter 36 linearly moves in the axial direction while maintaining the state in which the long hole 36 b is engaged with the movement restriction pin 37. When the cutter 36 moves in the distal direction, it enters into cutter guide grooves 23a, 24a of a first clamping member 23 and a second clamping member 24 described later.

  It should be noted that the movement restricting pins 37 are locked to control the movement of the cutter 36 in at least three places, one end, the other end, and between the one end and the other end, of the long hole 36b of the cutter 36. A locking portion 36c is formed.

  As shown in FIGS. 2 and 3, the sandwiching portion 13 has a shape that forms a longitudinal direction from the proximal end portion toward the distal end portion, and includes a first sandwiching member 23 that is also called a first jaw, and a second jaw. A second clamping member 24, also called a second clamping member 24, is rotatably connected on the base end side.

  The first clamping member 23 and the second clamping member 24 themselves preferably have insulating properties as a whole, except for electric circuit portions such as electrodes, heaters, and energization lines. Therefore, the first clamping member main body 25 constituting the first clamping member 23 and the second clamping member main body 26 constituting the second clamping member 24 are formed of an insulating material.

  A base portion 25 a that is a base end portion of the first holding member main body 25 is fixed to a distal end portion of the cylindrical body 33 of the shaft 12. On the other hand, a base portion 26 a that is a base end portion of the second holding member main body 26 is attached to the distal end portion of the cylindrical body 33 of the shaft 12 by a support pin 31 disposed in a direction orthogonal to the axial direction of the shaft 12. It is rotatably supported. Therefore, the second clamping member 24 can be opened and closed with respect to the first clamping member 23 by rotating around the axis of the support pin 31. Further, the second clamping member 24 is urged in an opening direction with respect to the first clamping member 23 by an elastic member 32 such as a leaf spring.

  When the first sandwiching member body 25 and the second sandwiching member body 26 are closed, the first sandwiching member body has a smooth curved surface such as a substantially circular shape or a substantially elliptical shape when the two are sandwiched. 25 and the outer surface of the 2nd clamping member main body 26 are formed. The outer surfaces of the base portions 25a and 26a are similarly formed in a smooth circular shape, but are configured to have a slightly smaller diameter than the distal end side, so that steps 25c and 26c are formed between the distal ends. ing. More specifically, the diameters of the base portions 25a and 26a when the first holding member main body 25 and the second holding member main body 26 are closed are substantially the same as or slightly smaller than the inner diameter of the sheath 34 (the cylindrical body 33 of the shaft 12). The diameters of the first and second holding member bodies 25 and 26 are larger than the inner diameter of the sheath 34. Therefore, when the sheath 34 is slid with respect to the cylindrical body 33, the sheath 34 can advance to a position covering the base portions 25a and 26a, but the progress is stopped at the positions of the steps 25c and 26c.

  With such a configuration, when the sheath 34 is slid toward the distal end against the urging force of the elastic member 32, the first clamping member 23 and the second clamping member 24 are closed as shown in FIG. On the other hand, when the sheath 34 is slid to the proximal end side from the state where the distal end portion of the sheath 34 covers the base portions 25a and 26a, the first clamping member 23 is moved by the urging force of the elastic member 32 as shown in FIG. On the other hand, the 2nd clamping member 24 opens.

  A cutter guide groove 23a is formed in the first holding member main body 25, and a cutter guide groove 24a is formed in the second holding member main body 26 so as to face each other when the holding portion 13 is closed. It is formed to be a direction along the direction. These cutter guide grooves 23a and 24a are structural portions for guiding the cutter 36 described above into the clamping portion 13 along the central axis in the longitudinal direction from the proximal end portion toward the distal end portion. In the closed state, the cutter 36 advances and retreats in a hole formed by combining the two cutter guide grooves 23a and 24a.

  4 is a plan view showing a first holding member of the treatment instrument, and FIG. 5 is a sectional view of the first holding member of the treatment tool taken along line 5-5 in FIG.

  As shown in FIGS. 2 to 5, a holding surface 25 b is formed on the first clamping member main body 25, and a first output as an energy output unit for applying high-frequency energy to the living tissue is applied to the holding surface 25 b. A high frequency electrode 21a is provided. As shown in FIGS. 2 and 3, a holding surface 26b is formed on the second clamping member main body 26, and the holding surface 26b serves as an energy output unit for applying high-frequency energy to the living tissue. Two high-frequency electrodes 21b are provided. The first high-frequency electrode 21a and the second high-frequency electrode 21b are members made of a conductive material.

  As shown in FIG. 4, the first high-frequency electrode 21 a is formed in a flat plate shape that fits on the inner peripheral side with respect to the edge of the holding surface 25 b, and extends along the axial direction of the first clamping member 23. Since the cutter guide groove 23a is formed as described above, for example, it is a substantially U-shaped flat plate.

  The second high-frequency electrode 21b is also formed with a cutter guide groove 24a, which is substantially a U-shaped flat plate, for example, in the same manner as the first high-frequency electrode 21a shown in FIG.

  Then, a gap maintaining portion 27 formed of an insulating material, for example, at the tip of the cutter guide groove 23a of the first clamping member main body 25, and an insulating material at the tip of the cutter guiding groove 24a of the second clamping member main body 26, for example. The gap maintaining portions 28 formed in the above are respectively provided. Correspondingly, the first high-frequency electrode 21a is provided with a hole 27h for inserting the gap maintaining portion 27 as shown in FIG. 6 (or FIG. 7 according to a modified example) described later. Although not shown, the second high-frequency electrode 21b is similarly provided with a hole through which the gap maintaining portion 28 is inserted.

  The gap maintaining portions 27 and 28 are formed so that when the first holding member 23 and the second holding member 24 are closed, the surface of the first high-frequency electrode 21a and the second high-frequency electrode 21a, which are a pair of holding surfaces facing each other. This is for maintaining the distance between the electrode surfaces with the surface of the high-frequency electrode 21b at a constant distance δ (see FIG. 2). The constant distance δ is preferably a distance between 0.2 mm and 0.7 mm, for example. In the example shown in FIGS. 2 to 5, when the first holding member 23 and the second holding member 24 are closed, the gap maintaining portions 27 and 28 come into contact with each other's heads 27 a and 28 a. It is formed as a boss (however, of course, it is not limited to the boss shape).

  As shown in FIGS. 2, 3, and 6, a resistance heater 22 is disposed on the back side of the first high-frequency electrode 21 a as an energy output unit that generates resistance heating energy. FIG. 6 is a perspective view showing the back surface of the first high-frequency electrode provided with a resistance heater.

  In the example shown in FIGS. 2, 3, and 6, the resistance heater 22 has a chip shape, and is discretely formed on the back surface of the first high-frequency electrode 21a along the substantially U-shape of the first high-frequency electrode 21a. It is arranged. However, the first high-frequency electrode 21a and the resistance heater 22 are insulated. When the resistance heater 22 generates heat, the heat is conducted to the first high-frequency electrode 21a, and the heat is transferred to the living tissue via the first high-frequency electrode 21a.

  In such a configuration, in order to transmit the heat generated from the resistance heater 22 to the first high-frequency electrode 21a with a small heat loss, the first holding member body 25 has only an insulating property as described above. In addition, it is preferable to cover the outer periphery of the resistance heater 22 with heat insulation.

  FIG. 7 is a perspective view showing another configuration example of the resistance heater provided on the back surface of the first high-frequency electrode 21a.

  The resistance heater 22A shown in FIG. 7 is an energy output unit formed in a U shape along the shape of the first high-frequency electrode 21a having a substantially U shape. Here, the U-shaped outer peripheral edge of the resistance heater 22A is an inner side that does not protrude from the U-shaped outer peripheral edge of the first high-frequency electrode 21a. The peripheral edge is the inner side that does not protrude from the U-shaped inner peripheral edge of the first high-frequency electrode 21a.

  Such a resistance heater 22A is, for example, a screen-printed thick film heating resistor or a thin film heating resistor formed by physical vapor deposition (PVD) on the back surface of the first high-frequency electrode 21a, It is formed as a disposed nichrome wire or other heating element.

  As shown in FIGS. 2 and 3, the first and second high-frequency electrodes 21a and 21b are connected to the first and second electrode connectors 21c and 21d provided at the base end portions, respectively. It is connected to the second high-frequency electrode energization lines 21 e and 21 f and further connected to the energy source 4 via the cable 16. The resistance heater 22 is connected to the heater energization line 22 a and further connected to the energy source 4 via the cable 16.

  The mutually facing surfaces of the first high-frequency electrode 21a and the second high-frequency electrode 21b are surfaces for contacting and sandwiching the living tissue, and an energy application surface for applying high-frequency energy and resistance heating energy to the living tissue. But there is.

  Therefore, in the present embodiment, this energy application surface (surfaces of the first high-frequency electrode 21a and the second high-frequency electrode 21b facing each other) is polytetrafluoroethylene (with a content of 30% (volume%) or more. It is covered with a coating member 29 made of Ni-PTFE which is nickel (Ni) containing PTFE) (in FIG. 4, the coating member 29 provided on the energy application surface of the first high-frequency electrode 21a is shown by hatching). ing). Here, PTFE is a polymer of tetrafluoroethylene, and is a fluororesin (fluorinated carbon resin) composed only of fluorine atoms and carbon atoms. PTFE is chemically stable and has excellent heat resistance and chemical resistance. The coating member 29 is formed by combining such PTFE fine particles with nickel Ni. The Ni-PTFE formed in this way has both the property of suppressing adhesion of living tissue and the conductivity.

  FIG. 8 is a graph showing an experimental example of the number of times that a living tissue does not adhere when the content of PTFE with respect to nickel Ni is varied under certain conditions. In FIG. 8, the vertical axis represents the adhesion durability (the number of times the biological tissue can be used without adhering), and the horizontal axis represents the content of PTFE in Ni-PTFE. Of the experimental results relating to the same content, hatched bar graphs indicate the results on the first high-frequency electrode 21 a side of the first clamping member 23, and normal bar graphs indicate the second in the second clamping member 24. The result on the high frequency electrode 21b side is shown.

  When the content of PTFE in Ni-PTFE is 25%, the first and second high-frequency electrodes 21a and 21b only show the adhesion durability of about 10 times.

  On the other hand, when the content of PTFE in Ni-PTFE is set to 30%, the first and second high-frequency electrodes 21a and 21b are attached to reach 20 times or more at least and 30 times at more. Shows durability. The result of the content rate of 30% shows a remarkable performance improvement as compared with the case of the content rate of 25%.

  Further, when the content of PTFE in Ni-PTFE is 38%, the first and second high-frequency electrodes 21a and 21b have an adhesion durability of 30 times or more at least and 50 times or more at the larger number. Show.

  For example, when the target value of adhesion durability is set to 20 times, it is considered that the target value is cleared when the content rate is 30% or more. Based on such experimental results, in the present embodiment, 30% (volume%) or more (desired) on the energy application surface (surfaces of the first high-frequency electrode 21a and the second high-frequency electrode 21b facing each other). The coating member 29 is made of Ni-PTFE containing PTFE at a content of 38%). Here, when heat-treating Ni-PTFE as a coating member, if the heat treatment temperature is 200 ° C. to 350 ° C., the composition ratio of fluorine F can be increased and the composition ratio of oxygen O, nickel Ni, and phosphorus P can be decreased. This is preferable because the durability is improved.

  FIG. 9 is a block diagram showing mainly the electrical configuration of the therapeutic treatment system.

  As shown in FIG. 9, the energy source 4 includes a control unit 40, a high frequency energy output circuit 41, a resistance heater driving circuit 42, and a display unit 43. A high-frequency energy output circuit 41, a resistance heater driving circuit 42, and a display unit 43 are connected to the control unit 40. Further, the foot switch 6 is also connected to the control unit 40.

  When the foot switch 6 is switched ON, the control unit 40 controls the high-frequency energy output circuit 41 and the resistance heater driving circuit 42 so that the treatment by the treatment instrument 2 is performed, and the foot switch 6 is switched OFF. The high-frequency energy output circuit 41 and the resistance heater driving circuit 42 are controlled so that the treatment is stopped. At the time of this therapeutic treatment, the control unit 40 further controls the display unit 43 to display various displays indicating the progress of the treatment. In addition, the display unit 43 has a display function when setting the control unit 40 and also has an operation input function related to the setting operation. As described above, the control unit 40 controls the therapeutic treatment system 1 in an integrated manner.

  The high frequency energy output circuit 41 is electrically connected to the high frequency electrode 21 (first high frequency electrode 21a and second high frequency electrode 21b) of the treatment instrument 2 and outputs high frequency energy to the high frequency electrode 21. is there. The high frequency energy output circuit 41 is further configured to detect the impedance of the circuit based on a signal flowing through the high frequency energy output circuit 41. Since the impedance relating to the treatment system 1 itself is known, the impedance Z of the living tissue sandwiched between the first high-frequency electrode 21a and the second high-frequency electrode 21b based on the detected impedance of the circuit. Can be calculated. Therefore, the high frequency energy output circuit 41 has a sensor function for measuring the impedance Z of the living tissue.

  The resistance heater driving circuit 42 is electrically connected to the resistance heater 22 of the treatment instrument 2 and outputs electrical energy for resistance heating to the resistance heater 22. The resistance heater driving circuit 42 further has a sensor function for measuring the heat generation temperature T of the resistance heater 22.

  Next, the operation of the treatment system 1 of the present embodiment will be described with reference to FIG. FIG. 10 is a flowchart showing a process when a treatment using high-frequency energy and thermal energy is performed on a living tissue using the therapeutic treatment system. The action of the therapeutic treatment system 1 also shows a therapeutic treatment method for treating a living tissue by applying energy.

  In performing the treatment, the surgeon turns on the power of the treatment system 1 and then operates the display unit 43 of the energy source 4 to output an output condition of the treatment system 1, for example, the set power Pset of the high frequency energy output. [W] (specifically, about 20 [W] to 80 [W]), set temperature Tset [° C.] of thermal energy output (specifically about 100 [° C.] to 300 [° C.]), The threshold values Z1 and Z2 of the impedance Z (here, Z1 <Z2, where Z1 is about 1000 [Ω] and Z2 is about 2000 [Ω]) are set in advance.

  When the series of settings is completed, the control unit 40 of the energy source 4 enters a state of waiting for the foot switch 6 to be turned on (step S11).

  After that, with the clamping unit 13 closed as shown in FIG. 2, for example, the clamping unit 13 and the shaft 12 of the treatment instrument 2 are inserted into the abdominal cavity through the body wall. Then, the surgeon confronts the sandwiching portion 13 of the treatment instrument 2 with the biological tissue to be treated.

  Next, the surgeon operates the clamping part opening / closing lever 14 of the handle 11 to hold the living tissue to be treated by the clamping part 13, and moves the sheath 34 to the proximal end part side of the shaft 12. When the sheath 34 is moved to a predetermined position, the urging force of the elastic member 32 cannot be locked by the sheath 34, and the second holding member 24 is moved relative to the first holding member 23 as shown in FIG. open.

  Then, the surgeon places the biological tissue to be treated between the first high-frequency electrode 21 a of the first holding member 23 and the second high-frequency electrode 21 b of the second holding member 24. In this state, the surgeon operates the holding portion opening / closing lever 14 of the handle 11 to move the sheath 34 toward the distal end side of the shaft 12. When the sheath 34 moves toward the distal end, the sheath 34 closes between the base portions 25a and 26a against the urging force of the elastic member 32, that is, as shown in FIG. 23, the second clamping member 24 is closed. In this way, the biological tissue to be treated is gripped between the first clamping member 23 and the second clamping member 24.

  That is, in other words, the living tissue to be treated is sandwiched between both the coating member 29 of the first high-frequency electrode 21a and the coating member 29 of the second high-frequency electrode 21b, which are energy application surfaces. It will be.

  Thus, the operator operates the foot switch 6 to ON while holding the living tissue. Then, the control unit 40 determines that the foot switch 6 is turned ON in step S11 described above, and controls the high frequency energy output circuit 41 to apply the high frequency energy of the set power Pset [W] described above to the high frequency electrode 21. Is output (step S12). Thereby, high-frequency energy is applied to the living tissue sandwiched between the first high-frequency electrode 21 a and the second high-frequency electrode 21 b via the coating member 29. Then, Joule heat is generated in the living tissue, the cell membrane is destroyed, the intracellular components and the extracellular components are made uniform, and cauterization is performed. As a result, the impedance Z of the living tissue increases.

  The impedance Z of the grasped living tissue at the time of outputting the high frequency energy is measured by the high frequency energy output circuit 41. The impedance Z when the treatment is started is, for example, about 60 [Ω]. As the high-frequency current flows through the living tissue and the living tissue is cauterized, the cells of the living tissue are dehydrated and the value of the impedance Z increases.

  The control unit 40 monitors the impedance Z detected by the high frequency energy output circuit 41, and determines whether the impedance Z is equal to or higher than a preset threshold value Z1 (step S13). The threshold value Z1 is set to a value that is known in advance when the rate of increase in the value of the impedance Z slows down (that is, a value that is known in advance that dehydration of the cells of the living tissue has progressed to some extent). When the control unit 40 determines that the impedance Z is smaller than the threshold value Z1, the control unit 40 continuously performs the process of step S12, that is, the process of applying high-frequency energy to the living tissue.

  At this time, after the clamping unit 13 is closed, even when the cells of the living tissue are dehydrated by applying high-frequency energy to the living tissue, the gap maintaining units 27 and 28 set the distance between the clamping surfaces described above. The fixed distance δ or more is maintained.

  When the control unit 40 determines that the impedance Z is equal to or greater than the threshold value Z1, the control unit 40 controls the resistance heater driving circuit 42 so that the resistance heater 22 has a preset temperature Tset [° C.]. Electric power is supplied to the heater 22 (step S14). At this time, the control unit 40 controls the power supplied to the resistance heater 22 while monitoring the heat generation temperature T of the resistance heater 22 measured by the resistance heater driving circuit 42. Thereby, the grasped living tissue is solidified by heat from the surface side of the living tissue in close contact with the first high-frequency electrode 21a toward the inside.

  As is well known, water has a large specific heat, and even if heat is applied in a state before dehydrating a living tissue, the temperature rises slowly. On the other hand, in this embodiment, since resistance heating energy is applied after dehydrating the living tissue to a certain level, the temperature of the living tissue can be efficiently increased with respect to the amount of heat applied. .

  The controller 40 continues to monitor the impedance Z detected by the high frequency energy output circuit 41, and determines whether the impedance Z is equal to or higher than a preset threshold value Z2 (step S15). The threshold value Z2 is set to a value that determines that the coagulation of the living tissue has been completed. Then, when the control unit 40 determines that the impedance Z is smaller than the threshold value Z2, the control unit 40 continues the process of step S14.

  On the other hand, when determining that the impedance Z is equal to or higher than the threshold value Z2, the control unit 40 generates a buzzer sound, for example, stops the high-frequency energy output circuit 41 from outputting high-frequency energy, and heats the resistance heater driving circuit 42. The output of energy is stopped (step S16).

  After that, when it is necessary to excise the living tissue to be treated after the living tissue is treated and before the energy application surface is detached from the living tissue, the operator operates the cutter drive lever 15. Then, the cutter 36 is moved in the distal direction. Thereby, the solidified living tissue between the clamping surfaces is cut by the blade 36a. The cut biological tissue is taken out of the abdominal cavity through the body wall, for example, while being held by the clamping unit 13, and the operator operates the clamping unit opening / closing lever 14 outside the abdominal cavity to open the clamping unit 13, thereby holding the clamping unit. Leave 13 At this time, since the coating member 29 is provided on the energy application surface in contact with the living tissue as described above, the grasped living tissue is easily and reliably detached.

  Further, when it is not necessary to excise the living tissue to be treated, the operator operates the holding portion opening / closing lever 14 to open the holding portion 13 in the abdominal cavity after coagulating the living tissue. Then, the biological tissue is detached from the clamping unit 13. The removal of the living tissue at this time is of course easy and reliable.

  When there is a further living tissue to be treated, the above-described processing is performed in the same manner. Thus, when the treatment for all the biological tissues to be treated is completed, the treatment of the biological tissue using the therapeutic treatment system 1 is completed.

  According to such 1st Embodiment, the following effects are acquired.

  Coagulation treatment is performed by applying high-frequency energy to the living tissue to destroy the cell membrane, increasing the thermal conductivity of the living tissue, and then applying resistance heating energy from the resistance heater 54 to the living tissue. For this reason, resistance heating energy can be applied in an efficient state.

  Furthermore, the state of the living tissue grasped by the holding unit 13 (impedance Z of the living tissue, temperature T of the resistance heater 22 that applies heat to the living tissue, etc.) is monitored, and based on a preset threshold value Z1. Switching time from high-frequency energy input to heat energy input is automatically determined and switched, and the energy input end time is automatically determined based on a preset threshold value Z2. For this purpose, treatment variations due to the operator's senses are prevented, and treatments are performed efficiently and stably according to the state of tissue degeneration (cauterized or coagulated) to make the tissue uniform (stable ).

  In this way, it is possible to efficiently perform treatment on living tissue with less energy input loss as much as possible without bothering the surgeon, shortening the treatment time, and greatly reducing the burden on the patient. Can do.

  Since the Ni-PTFE coating member 29 containing PTFE with a content of 30% (volume%) or more is provided on the energy application surface for applying high-frequency energy or resistance heating energy to the living tissue, as shown in FIG. In addition, the number of times that the living tissue can be used without adhering to the energy application surface can be greatly improved.

  Therefore, when the clamping unit 13 is opened, the living tissue can be more reliably and easily detached from the energy application surface. In addition, for example, the number of biological tissues that can be treated with the therapeutic treatment tool 2 inserted into the abdominal cavity through the body wall (the number of biological tissues that can be treated without removing the therapeutic treatment tool 2) is increased. can do. Thus, the operability of the treatment instrument 2 can be improved.

  In addition, it is known that the effect of treatments such as coagulation and hemostasis is reduced when a proteolytic substance due to heat generated when energy is applied adheres to the energy application surface or is further fixed by scorching. On the other hand, according to the present embodiment, it is possible to suppress the adhesion and adhesion of proteins or the like to the energy application surface, and thus it is possible to prevent a reduction in treatment effect.

[Second Embodiment]
11 and 12 show a second embodiment of the present invention. FIG. 11 is a plan view showing the shape of the first high-frequency electrode provided on the first clamping member. FIG. 12 shows the first embodiment. 12 is a cross-sectional view taken along line 12-12 of FIG. 11 showing the configuration of the first clamping member provided with the high-frequency electrode.

  As in the first embodiment described above, the present embodiment is an embodiment in which the treatment instrument (energy treatment instrument) is a linear treatment instrument 2, but the shape of the high-frequency electrode is different. .

  As shown in FIGS. 11 and 12, in the configuration of the present embodiment, the configurations of the cutter 36, the cutter guide grooves 23a, 24a, and the like are omitted.

  Furthermore, instead of the boss-shaped gap maintaining portion 27 in the first embodiment, the holding surface 25b ′ of the first holding member body 25 is formed in a wall shape so as to surround the outer periphery of the edge of the first high-frequency electrode 21a ′. The gap maintaining portion is configured upright. That is, the holding surface 25b 'is configured to be closer to the second holding member body 26 than the surface of the first high-frequency electrode 21a' that is a member formed of a conductive material. Although not shown, the holding surface of the second holding member main body 26 is configured in the same manner, and the holding surface 25b ′ of the first holding member main body 25 and the holding surface of the second holding member main body 26 are formed. The distance between the electrode surfaces at the time of contact is maintained at a constant distance δ (see FIG. 2). As described above, the constant distance δ is preferably a distance between 0.2 mm and 0.7 mm, for example.

  The first high-frequency electrode 21a 'provided in the first clamping member main body 25 is not provided with a cutter guide groove, and has a flat plate shape. Therefore, the energy application surface of the first high-frequency electrode 21a 'facing the second clamping member 24 is formed in a plane. Although not shown, the energy application surface of the second high-frequency electrode facing the first clamping member 23 is similarly formed in a flat surface.

  Then, PTFE having a content of 30% (volume%) or more (an example of a desirable value is 38%) as described above on the energy application surfaces of the first high-frequency electrode 21a ′ and the second high-frequency electrode facing each other. The Ni-PTFE coating member 29 is formed (in FIG. 11, the coating member 29 provided on the energy application surface of the first high-frequency electrode 21a ′ is indicated by hatching).

  According to such 2nd Embodiment, when using a flat high frequency electrode, there can exist an effect substantially the same as 1st Embodiment mentioned above.

[Third Embodiment]
FIG. 13 shows a third embodiment of the present invention, and is a side view showing a configuration of a clamping portion configured as a seesaw type of a treatment instrument. In the third embodiment, portions similar to those in the first and second embodiments described above are denoted by the same reference numerals, description thereof is omitted, and only different points will be mainly described.

  In the present embodiment, the therapeutic treatment tool (energy treatment tool) is a linear type therapeutic treatment tool 2, and a seesaw type jaw is further employed.

  The clamping unit 13 disposed on the distal end side of the shaft 12 includes a first clamping member 23 and a second clamping member 24.

  The first clamping member 23 includes a first clamping member main body 25, and the first clamping member main body 25 is provided integrally with the shaft 12 so as to extend in the axial direction of the shaft 12. .

  The second clamping member 24 includes a proximal-side clamping unit pivot body 26A and a distal-side second clamping member main body 26B, and is based on the clamping unit pivot body 26A. The end side is pivotally supported with respect to the shaft 12 and the first holding member 23 via the rotation shaft 52. The second sandwiching member main body 26B is pivotally supported via the swing shaft 51 with respect to the sandwiching portion pivot support body 26A. That is, the second clamping member 24 is a second clamping member main body 26 </ b> B pivotally supported by the swing shaft 51 as a seesaw portion that brings the clamping surface in parallel with the clamping surface of the first clamping member 23. It has the structure which has.

  A cam hole 53 is formed on the proximal end side of the sandwiching portion pivot body 26 </ b> A with respect to the rotation shaft 52. On the other hand, an axial cam hole 54 is formed in the shaft body 12 a of the shaft 12. And the cam hole 53 and the cam hole 54 are comprised so that it may mutually cross | intersect, and the cam pin 55 is engaged so that it may penetrate in an intersection position. The cam pin 55 is fixed to the distal end side of the opening / closing drive shaft 56. On the other hand, the proximal end side of the opening / closing drive shaft 56 is mechanically connected to the clamping portion opening / closing lever 14 (see FIG. 1 and the like).

  By adopting such a cam mechanism, when the holding portion opening / closing lever 14 (see FIG. 1 or the like) is operated and the opening / closing drive shaft 56 is moved to the distal end side, the second holding member with respect to the first holding member 23. 24 opens. On the other hand, when the opening / closing drive shaft 56 is moved to the proximal end side by operating the holding portion opening / closing lever 14 (see FIG. 1 and the like), the second holding member 24 is closed with respect to the first holding member 23.

  A first high frequency electrode 21a is provided on the holding surface 25b of the first holding member main body 25, and a second high frequency electrode 21b is provided on the holding surface 26Bb of the second holding member main body 26B. The above-described energy application surfaces of the first high-frequency electrode 21a and the second high-frequency electrode 21b have a PTFE content of 30% (volume%) or more (an example of a desirable value is 38%) as described above. A Ni-PTFE coating member 29 containing s is formed.

  Furthermore, a gap maintaining portion 27A formed in a boss shape with an insulating material is provided so as to protrude from the surface of the first high-frequency electrode 21a facing the second high-frequency electrode 21b. The gap maintaining portion 27A is in contact with the surface of the second high-frequency electrode 21b facing the first high-frequency electrode 21a, and the distance between the electrode surfaces of the first high-frequency electrode 21a and the second high-frequency electrode 21b is constant. The distance δ (see FIG. 2) is maintained. As described above, the constant distance δ is preferably a distance between 0.2 mm and 0.7 mm, for example.

  According to such 3rd Embodiment, also in the treatment instrument provided with a seesaw type jaw, the effect similar to 1st, 2nd embodiment mentioned above can be show | played.

  In the above description, an example in which one of the pair of clamping members is fixed to the shaft and the other clamping member is configured to be rotatable with respect to the shaft as a linear treatment instrument has been described. Of course, it does not matter if the holding member is configured to be rotatable with respect to the shaft.

[Fourth Embodiment]
FIGS. 14 and 15 show a fourth embodiment of the present invention, FIG. 14 is a perspective view showing the configuration of a therapeutic treatment system including a circular type therapeutic treatment instrument, and FIG. 15 shows a therapeutic treatment instrument. It is a top view which shows the structure of the clamping surface of a main body side clamping part.

  In the fourth embodiment, portions similar to those in the first to third embodiments described above are denoted by the same reference numerals, description thereof is omitted, and only different points will be mainly described.

  In the present embodiment, the therapeutic treatment tool (energy treatment tool) is a circular type bipolar therapeutic treatment tool 102 for performing a treatment through, for example, a body wall or outside the body wall.

  As shown in FIG. 14, the therapeutic treatment system 101 includes a therapeutic treatment instrument 102, an energy source 4, and a foot switch 6. The treatment instrument 102 includes a handle 111, a shaft 112, and an openable / closable clamping portion 113. The energy source 4 is connected to the handle 111 via the cable 16. The holding part 113 includes a main body side holding part 123 and a detachable side holding part 124 configured to be able to perform separation / proximity with respect to the main body side holding part 123.

  The handle 111 is provided with a clamping portion opening / closing knob 114 that is a rotatable operation member and a cutter drive lever 115 that is a swingable operation member. For example, when the clamping part opening / closing knob 114 is rotated clockwise with respect to the handle 111, the detaching side clamping part 124 of the clamping part 113 is separated from the body side clamping part 123, and when it is rotated counterclockwise, the detaching side clamping is performed. The part 124 is close to the main body side clamping part 123.

  The shaft 112 is formed in an elongated cylindrical shape. In the example shown in FIG. 14, the shaft 112 is appropriately curved in consideration of the insertion property into the living tissue. Of course, the shaft 112 may be formed in a straight line.

  A clamping portion 113 is disposed at the tip of the shaft 112. The sandwiching portion 113 is a first sandwiching member formed at the tip of the shaft 112 and is also referred to as a first jaw, and a second sandwiching member that can be attached to and detached from the body sandwiching portion 123. A detachable side holding portion 124 also called a second jaw is provided. In a state where the detachable side clamping unit 124 is closed with respect to the main body side clamping unit 123, the holding surface 125Ba (see FIG. 15) of the main body side clamping unit 123 is in contact with the holding surface of the detachable side clamping unit 124.

  As shown in FIG. 15, the main body side clamping portion 123 includes a cylindrical body 125 </ b> B, a frame 125 </ b> A, and an energization pipe 131. The cylindrical body 125B and the frame 125A have insulating properties. The cylindrical body 125B is connected to the tip of the shaft 112. The frame 125A is disposed on the inner peripheral side of the cylindrical body 125B while being fixed to the cylindrical body 125B.

  The frame 125A has a cylindrical shape with a central axis portion serving as a communication hole. An energization pipe 131 is disposed in the communication hole in the central axis portion of the frame 125A so as to be movable within a predetermined range along the central axis of the frame 125A. The energization pipe 131 is connected to the cable 16 via the shaft 112 and the handle 111. Then, the movement of the energizing pipe 131 along the central axis of the frame 125 </ b> A is performed by the rotation of the holding portion opening / closing knob 114.

  A cutter guide groove (space) 123a is formed between the cylindrical body 125B and the frame 125A. A cylindrical cutter 136 is disposed in the cutter guide groove 123a. The base end portion of the cutter 136 is connected to the cutter driving lever 115 of the handle 111 via a mechanism (not shown). For this reason, when the cutter driving lever 115 of the handle 111 is operated, the cutter 136 moves in the direction along the central axis of the frame 125A and moves forward and backward.

  A first high-frequency electrode 121a and a resistance heater 122 are disposed as an energy output unit on the outer peripheral side of the cutter guide groove 123a at the tip of the cylindrical body 125B. The first high-frequency electrode 121a is for outputting high-frequency energy, and is a member formed in an annular shape with a conductive material. In addition, a plurality of resistance heaters 122 are discretely arranged on the circumference of the back surface of the first high-frequency electrode 121a at appropriate regular intervals.

  Although not shown, the second high-frequency electrode of the detachable side holding portion 124 is also a member formed in an annular shape with a conductive material, like the first high-frequency electrode 121a of the main body side holding portion 123.

  On the outer peripheral side of the first high-frequency electrode 121a, a holding surface (tissue contact surface) 125Ba is formed as a gap maintaining portion so as to be positioned higher than the surface of the first high-frequency electrode 121a. Similar to the holding surface (tissue contact surface) 125Ba, the holding surface which is located higher than the surface of the second high-frequency electrode is also not shown on the outer peripheral side of the second high-frequency electrode of the detachable side holding portion 124. Is formed as a gap maintaining portion. The distance between the electrode surfaces when the holding surface 125Ba of the main body side holding portion 123 and the holding surface of the detachable side holding portion 124 come into contact with each other is maintained at a constant distance δ (see FIG. 2). . As described above, the constant distance δ is preferably a distance between 0.2 mm and 0.7 mm, for example.

  The energy application surfaces of the first high-frequency electrode 121a and the second high-frequency electrode (not shown) facing each other have a content of 30% (volume%) or more (an example of a desirable value is 38%) as described above. A Ni-PTFE coating member 29 containing PTFE is formed (in FIG. 15, the coating member 29 provided on the energy application surface of the first high-frequency electrode 121a is indicated by hatching).

  Next, the operation of the treatment system 101 according to this embodiment will be described.

  With the main body side clamping portion 123 closed with respect to the detachable side clamping portion 124, for example, the clamping portion 113 and the shaft 112 of the treatment instrument 102 are inserted into the abdominal cavity through the body wall. And the clamping part 113 is made to oppose the biological tissue which wants to treat.

  Next, the clamping part opening / closing knob 114 of the handle 111 is operated to rotate, for example, clockwise. Then, the detachable side clamping part 124 moves in the distal direction, and the detachable side clamping part 124 is detached from the main body side clamping part 123.

  Then, the biological tissue to be treated is placed between the main body side holding portion 123 and the detachable side holding portion 124 in the opened state. In this state, the holding portion opening / closing knob 114 of the handle 111 is operated to rotate, for example, counterclockwise. As a result, the detachable side clamping part 124 comes close to the main body side clamping part 123 side, and the biological tissue to be treated is in contact with the first high frequency electrode 121a of the main body side clamping part 123 and the second high frequency electrode of the detachable side clamping part 124. Held between.

  Thereafter, the living tissue is heated by Joule heat by the application of high-frequency energy, and the living tissue is coagulated by the application of resistance heating energy, as in the first embodiment described above.

  When the application of energy to the living tissue is finished, the living tissue is denatured continuously (substantially annular or arcuate).

  Subsequently, when it is necessary to excise the living tissue to be treated, the operator operates the cutter drive lever 115 to move the cutter 136 in the distal direction. Thereby, the solidified living tissue is cut into a circular shape or an arc shape. When detaching the cut biological tissue from the clamping unit 113, the clamping unit 113 is opened by operating the clamping unit opening / closing knob 114. At this time, since the coating member 29 is provided on the energy application surface in contact with the living tissue as described above, the grasped living tissue is easily and reliably detached.

  Further, when it is not necessary to excise the living tissue to be treated, the operator operates the holding portion opening / closing knob 114 to open the holding portion 113 in the abdominal cavity after coagulating the living tissue. Then, the biological tissue is detached from the sandwiching portion 113. The removal of the living tissue at this time is of course easy and reliable.

  According to such 4th Embodiment, the effect similar to 1st-3rd Embodiment mentioned above can be show | played also in a circular type therapeutic treatment tool. Furthermore, if a circular type therapeutic treatment tool is used, it becomes possible to seal biological tissues in a substantially annular shape.

  In the above description, the configuration example in which the energy output unit is provided on both of the pair of holding surfaces as the treatment instrument has been described. However, the energy output unit may be provided on only one of the pair of holding surfaces.

[Fifth Embodiment]
FIG. 16 shows a fifth embodiment of the present invention, and is a perspective view showing a configuration of an electric knife as a therapeutic treatment instrument. In the fifth embodiment, the description of the same parts as those in the first to fourth embodiments will be omitted as appropriate, and only different points will be mainly described.

  In the present embodiment, the treatment instrument (energy treatment instrument) is a monopolar electric knife 201.

  The main body 211 of the electric knife 201 is configured in, for example, an elongated stick shape so that the operator can hold it with, for example, one hand. A plurality of (two in the example shown in FIG. 16) operation switches 214 and 215 for operating the electric knife 201 are provided on the side surface of the main body 211. For example, one of these operation switches 214 and 215 is for generating or stopping an incision mode high frequency signal, and the other is for generating or stopping a coagulation mode high frequency signal. However, the number and function of the switches are not limited to this example.

  A knife tip 213 is attached to the distal end side of the main body 211 via an attachment portion 212. The knife tip 213 is a high-frequency electrode formed of, for example, a spatula with a conductive material so that a high-frequency signal can be applied to a living tissue.

  On the energy application surface of the knife tip 213, the Ni-PTFE coating member 29 containing PTFE is formed with a content of 30% (volume%) or more (an example of a desirable value is 38%) as described above. In FIG. 16, the coating member 29 provided on the energy application surface of the knife tip 213 is indicated by hatching.

  The electric knife 201 is connected to an electric knife apparatus main body (not shown) via a cable 216. The electric knife device main body is an energy source that supplies high-frequency energy to the electric knife 201. Since the electric knife 201 is a monopolar type treatment instrument, a counter electrode plate (not shown) for collecting high-frequency energy applied from the electric knife 201 to the living tissue is further connected to the electric knife device body. Yes.

  When the operation switch 214 or 215 is turned ON, the electric knife apparatus main body is driven, and a high frequency treatment signal in a mode corresponding to the ON operation switch is input to the electric knife 201. The high frequency energy applied to the living tissue from the electric knife 201 is collected via the living tissue from the counter electrode installed in a state in contact with the subject over a wide area to the electric knife apparatus body.

  In the incision mode, high-frequency energy is continuously applied to the living tissue that contacts the scalpel tip 213, moisture in the living tissue heated by Joule heat boils and evaporates, and the living tissue is cut. .

  In the coagulation mode, high-frequency energy is intermittently applied to the living tissue contacting the knife tip 213, and the living tissue heated by Joule heat is denatured and coagulated.

  Since the coating member 29 is provided on the energy application surface in contact with the living tissue as described above, the living tissue adheres to the scalpel tip 213 in either the incision mode or the coagulation mode. Is more reliably prevented.

  According to the fifth embodiment as described above, even when the treatment instrument is an electric knife, substantially the same effects as those of the first to fourth embodiments described above can be obtained.

[Sixth Embodiment]
FIG. 17 shows a sixth embodiment of the present invention, and is a perspective view showing a configuration of bipolar tweezers as a treatment instrument. In the sixth embodiment, portions similar to those in the first to fifth embodiments described above are denoted by the same reference numerals, description thereof is omitted, and only different points will be mainly described.

  In the present embodiment, the therapeutic treatment tool (energy treatment tool) is a bipolar tweezers 301.

  The bipolar tweezers 301 includes a tweezer main body 311 formed in a shape having a pair of arms that can be opened and closed. A restricting portion 312 for restricting the closed position when the arm is closed is formed in the middle of the pair of arms of the tweezer main body 311 facing slightly toward the inner surface.

  On the distal end side of the pair of arms of the tweezer main body 311, a distal end tip portion 313 which is a high frequency electrode for applying a high frequency signal to a living tissue is formed of a conductive material.

  The Ni-PTFE coating member 29 containing PTFE at a content of 30% (volume%) or more (an example of a desirable value is 38%) as described above is formed on the energy application surface of the pair of tip portions 313. (In FIG. 17, the coating member 29 provided on the energy application surface of the tip portion 313 is indicated by hatching).

  A cable 316 extends from the proximal end side of the tweezer main body 311 and is connected to a bipolar tweezer main body (not shown). The main body of the bipolar tweezers is an energy source that supplies high-frequency energy to the pair of tip portions 313 of the bipolar tweezers 301.

  The bipolar tweezers 301 is normally open due to the elastic force of the tweezer main body 311 itself. In this open state, the pair of arms are electrically insulated from each other. In use, the pair of distal tip parts 313 is closed by the operator holding the tweezer main body 311 and applying a force in a direction in which the pair of arms are brought close to each other from both outer side surfaces. At this time, by sandwiching the living tissue between the pair of tip parts 313, the high-frequency current is transmitted from one tip part 313 to the other tip part 313 via the sandwiched living tissue. . Thereby, treatments such as coagulation, hemostasis, and incision are performed on the living tissue.

  Since the coating member 29 is provided on the energy application surface of the tip part 313 that is in contact with the living tissue as described above, it is possible to more reliably prevent the living tissue from adhering to the tip part 313. Is done.

  According to the sixth embodiment, even when the treatment instrument is bipolar tweezers, it is possible to achieve substantially the same effects as those of the first to fifth embodiments described above.

[Seventh Embodiment]
FIG. 18 shows a seventh embodiment of the present invention, and is a side view showing a configuration of a snare-type incision and excision tool as a therapeutic treatment tool. In the seventh embodiment, the same parts as those in the first to sixth embodiments described above are denoted by the same reference numerals, description thereof is omitted, and only different points will be mainly described.

  In the present embodiment, the treatment instrument (energy treatment instrument) is a snare-type incision / excision instrument 401.

  The snare type incision and excision tool 401 includes an operation unit 411 and an elongated insertion unit 412 extending from the operation unit 411 toward the distal end side.

  The operation unit 411 includes an operation unit main body 415 and a slider 416 that can advance and retreat along the axial direction of the operation unit main body 415.

  The insertion portion 412 is a member formed of a flexible tubular sheath 414 formed of an insulating resin or the like and a conductive material that is inserted into the sheath 414 so as to be movable in the longitudinal direction. A wire 413.

  A proximal end portion 414a of the sheath 414 is detachably connected to the operation portion main body 415. On the other hand, the base end portion 413 a of the wire 413 is connected to the slider 416. When the slider 416 is positioned at the distal end of the operation unit main body 415, the wire 413 protrudes from the distal end opening of the sheath 414, and when the slider 416 is positioned at the proximal end of the operation unit main body 415. The tip 413b is long enough to be accommodated in the sheath 414.

  The wire 413 is formed by, for example, twisting a plurality of black tungsten strands or a plurality of strands of silver stainless steel strands and black tungsten strands.

  The tip portion 413b of the wire 413 forms a snare portion, and forms a swollen loop shape in a natural state protruding from the sheath 414 as shown in FIG.

  On the other hand, when the distal end portion 413b of the wire 413 is accommodated in the sheath 414, an external force converged from the sheath 414 is applied to the distal end portion 413b so that the loop shape is linearized.

  At least the surface (energy application surface) of the distal end portion 413b that protrudes from the distal end opening of the sheath 414 when the slider 416 is positioned at the distal end of the operation unit main body 415 is 30% (volume%) as described above. ) A Ni-PTFE coating member 29 containing PTFE with a content of 38% or more is desirable (in FIG. 18, the coating member 29 provided on the energy application surface of the tip 413b (Indicated by hatching).

  The base end portion 413 a of the wire 413 described above is connected to a metal high-frequency power supply pin 417 provided on the slider 416. The high frequency power supply pin 417 is connected to an energy source (not shown) that supplies a high frequency current.

  Next, the operation of the snare type incision and excision tool 401 of this embodiment will be described. Here, an operation in the case of performing treatment by inserting the snare-type incision and excision tool 401 through a treatment tool channel of an endoscope (not shown) will be described.

  Before performing the treatment, the slider 416 is pulled toward the proximal end side of the operation unit main body 415, and the distal end portion 413 b of the wire 413 is stored in the sheath 414.

  Then, after inserting the endoscope into the body cavity, the insertion portion 412 in a state where the distal end portion 413b is housed in the sheath 414 is inserted into the treatment instrument channel of the endoscope.

  While observing with an endoscope, a biological tissue to be treated in a body cavity, for example, a protruding biological tissue such as a polyp is searched. When the living tissue to be treated is captured within the field of view of the endoscope, the slider 416 is moved toward the distal end side of the operation unit main body 415 with the distal end of the sheath 414 protruding from the distal end opening of the treatment instrument channel of the endoscope. Slide. Then, the tip 413b of the wire 413 protrudes from the sheath 414 to form a loop.

  The surgeon performs an operation of placing the looped tip 413b on the living tissue to be treated. When this operation is performed, the surgeon pulls the slider 416 toward the proximal end side. Thereby, the front-end | tip part 413b of the wire 413 is drawn in in the sheath 414, and the biological tissue of treatment object is bound.

  When the living tissue to be treated is bound, a high-frequency current is supplied to the power supply pin 417 from an energy source (not shown), whereby a high-frequency current flows through the wire 413 and the living tissue to be treated is excised by high-frequency incision.

  At this time, since the coating member 29 is provided on the energy application surface of the tip 413b of the wire 413 that is in contact with the living tissue as described above, the living tissue is more reliably attached to the tip 413b. To be prevented.

  According to the seventh embodiment, even when the treatment instrument is a snare type incision and excision tool, substantially the same effects as those of the first to sixth embodiments described above can be obtained.

  In the above description, some examples of a treatment instrument that applies at least high-frequency energy to a living tissue have been described. However, the treatment instrument may include a ball electrode (ball-type high-frequency electrode), a probe including a high-frequency electrode, or Even in the case of a treatment instrument that applies other high-frequency energy, the same effects as those of the above-described embodiments can be obtained by providing the above-described coating member 29 on the energy application surface.

  Note that the present invention is not limited to the above-described embodiment as it is, and can be embodied by modifying the constituent elements without departing from the scope of the invention in the implementation stage. In addition, various aspects of the invention can be formed by appropriately combining a plurality of components disclosed in the embodiment. For example, you may delete some components from all the components shown by embodiment. Furthermore, the constituent elements over different embodiments may be appropriately combined. Thus, it goes without saying that various modifications and applications are possible without departing from the spirit of the invention.

  This application is filed in USSN 61 / 777,466, filed in the United States on March 12, 2013, as a basis for claiming the priority, and the above disclosure includes the present specification, claims, and drawings. Shall be cited in

A therapeutic treatment tool according to an aspect of the present invention is a therapeutic treatment tool for applying energy to a living tissue, an energy output unit including an energy application surface for applying high-frequency energy to the living tissue, and 30% or more and 38%. A coating member that is made of Ni-PTFE, which is nickel (Ni) containing polytetrafluoroethylene (PTFE) at a content of up to and covers the energy application surface.

According to another aspect of the present invention, there is provided a therapeutic treatment method for treating a biological tissue by applying energy, wherein an energy application surface is brought into contact with the biological tissue, and the energy application surface is contacted with the biological tissue. It is made of Ni-PTFE which is nickel (Ni) containing polytetrafluoroethylene (PTFE) at a content of 30% or more and 38% while being in contact with the coating member covering the energy application surface. When the high-frequency energy is applied to the living tissue from the energy application surface and the cells of the living tissue are dehydrated by applying the high-frequency energy to the living tissue, the resistance heating energy is applied from the energy application surface to the living body. Applying to the tissue to treat the biological tissue, treating the biological tissue, The energized surface covered by Ingu member, a method of separating from the living body tissue.

Claims (14)

In a therapeutic treatment device for treating a living tissue by applying energy,
An energy output unit having an energy application surface for applying high-frequency energy to the living tissue;
A coating member made of Ni-PTFE, which is nickel (Ni) containing polytetrafluoroethylene (PTFE) at a content of 30% or more, and covers the energy application surface;
A therapeutic treatment instrument comprising:   The treatment tool according to claim 1, wherein the energy output unit applies resistance heating energy to the living tissue in addition to the high-frequency energy.   The therapeutic treatment device according to claim 2, wherein the energy output unit includes a high-frequency electrode that generates the high-frequency energy, and a resistance heater that generates the resistance heating energy.   The treatment tool according to claim 1, wherein the energy application surface is a surface formed on a member formed of a conductive material. And further comprising a pair of openable and closable clamping portions having a pair of opposed clamping surfaces for clamping the living tissue,
The treatment apparatus according to claim 1, wherein the energy output unit is provided on at least one of the pair of clamping surfaces.   The therapeutic treatment according to claim 5, wherein the pair of sandwiching portions has a shape that forms a longitudinal direction from the proximal end portion toward the distal end portion, and is rotatably connected on the proximal end side. Ingredients. One of the pair of sandwiching portions is fixed at the proximal end portion to the insertion portion provided on the proximal end side with respect to the sandwiching portion for insertion into the living tissue,
The treatment instrument according to claim 6, wherein the other of the pair of clamping parts is configured to be rotated with respect to one of the pair of clamping parts.   The treatment instrument according to claim 7, wherein the other of the pair of sandwiching portions has a seesaw portion that brings a sandwiching surface in parallel with one sandwiching surface of the pair of sandwiching portions. . Further comprising a cutter for cutting the living tissue,
8. The pair of sandwiching portions includes a cutter guide groove for guiding the cutter so as to advance and retract along a central axis in a longitudinal direction from the proximal end portion toward the distal end portion. The therapeutic treatment device described in 1.   The treatment instrument according to claim 5, further comprising a gap maintaining portion for maintaining a distance between the opposing clamping surfaces at a constant distance when the pair of clamping portions are closed.   The therapeutic treatment instrument according to claim 10, wherein the predetermined distance is a distance between 0.2 mm and 0.7 mm. In a therapeutic treatment method for treating a living tissue by applying energy,
Bringing the energy application surface into contact with the living tissue;
A coating made of Ni-PTFE, which is nickel (Ni) containing polytetrafluoroethylene (PTFE) at a content of 30% or more with the energy application surface kept in contact with the living tissue, and covering the energy application surface Applying high-frequency energy from the energy application surface to the living tissue via a member,
When the cells of the living tissue are dehydrated by applying the high-frequency energy to the living tissue, the resistive heating energy is applied to the living tissue from the energy application surface to treat the living tissue,
After the biological tissue is treated, the energy application surface covered with the coating member is detached from the biological tissue.
A therapeutic treatment method characterized by the above. The energy application surface is provided on at least one sandwiching surface of a pair of openable and closable portions having a pair of opposed sandwiching surfaces for sandwiching the living tissue, and the energy application surface is In contacting the living tissue, the pair of sandwiching portions are closed,
After the pair of sandwiching portions are closed, the gap maintaining portion reduces the distance between the sandwiching surfaces to 0 even after the cells of the living tissue are dehydrated by applying the high-frequency energy to the living tissue. The therapeutic treatment method according to claim 12, wherein the therapeutic treatment method is maintained over a certain distance between 2 mm and 0.7 mm.   The biological tissue between the clamping surfaces is cut by a cutter for cutting the biological tissue after the biological tissue is treated and before the energy application surface is detached from the biological tissue. The therapeutic treatment method according to claim 13.

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